# TAILORx: adjuvant chemotherapy guided by the 21-gene recurrence score in hormone receptor-positive, node-negative breast cancer

Source: https://onco.cc/key-papers/paper-tailorx-nejm-2018/  
OnCo record `paper-tailorx-nejm-2018` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Women with hormone receptor-positive, HER2-negative, node-negative breast cancer and a mid-range 21-gene recurrence score did just as well with endocrine therapy alone as with chemotherapy added, sparing most of them chemotherapy.

## Summary

Prospective trial of 10,273 women with hormone receptor-positive, HER2-negative, axillary node-negative breast cancer; those with a recurrence score of 11 to 25 (6,711 women) were randomised to endocrine therapy alone or chemoendocrine therapy.

Nine-year invasive disease-free survival was 83.3 percent with endocrine therapy against 84.3 percent with chemoendocrine therapy, meeting non-inferiority. Some benefit from chemotherapy was seen in women aged 50 or younger with scores of 16 to 25.

## Fields

- Kind: Key paper
- Last checked: 2026-09-17
- Journal: New England Journal of Medicine
- Year: 2018
- DOI: 10.1056/NEJMoa1804710
- Authors: Sparano JA, Gray RJ, Makower DF, et al.
- Findings: Nine-year invasive disease-free survival 83.3 percent vs 84.3 percent for scores 11 to 25 (hazard ratio 1.08, non-inferior).; Women 50 or younger with scores 16 to 25 had some chemotherapy benefit.
- What it means: Most women with node-negative hormone receptor-positive breast cancer can safely skip chemotherapy on the basis of a genomic assay; the exception is premenopausal women with scores in the upper part of the intermediate range.
- Caveats: The benefit in younger women may partly reflect chemotherapy-induced ovarian suppression.; Node-positive disease was addressed separately in RxPONDER.

## Sources

- N Engl J Med 2018: https://doi.org/10.1056/NEJMoa1804710
- PubMed: https://pubmed.ncbi.nlm.nih.gov/29860917/

## Connected records

- cancers: [High-risk early HR-positive breast cancer](https://onco.cc/cancers/hr-positive-early-high-risk/)
- trials: [TAILORx](https://onco.cc/trials/tailorx/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)

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